Moderate consumption of beer is associated with lower cardiovascular (CV) risk

Some evidence suggests a pint a day may reduce the risk of heart attacks and strokes by up to 30 per cent (www.dailymail.co.uk/health/article-2354880/Cheers-Just-ONE-pint-beer-boosts-heart-health-improving-blood-flow-make-arteries-flexible.html,
https://headoverbeers.wordpress.com/2013/07/17/a-beer-a-day-keeps-the-doctor-away/).
(www.fitnesshealth101.com/news/2011/11/18/one-beer-per-day-reduces-heart-disease-risk-studies-show/)

Cardiovascular disease is the number one cause of death in U.S., but moderate drinking can reduce risks 40-60% [Journal, Alcoholism, 2004] and the benefits of alcohol on the heart has been known since 1904 [Journal of the AMA, 1904]....Medical research has demonstrated a strong relationship between moderate alcohol consumption and reduction in cardiovascular disease in general and coronary artery disease in particular. [Moore, R., and Pearson, T. Moderate alcohol consumption and coronary artery disease. Medicine, 1986, 65 (4), 242-267. ]
The National Institute on Alcohol Abuse and Alcoholism found that moderate drinking is beneficial to heart health, resulting in a sharp decrease in heart disease risk (40%-60%). [Highlights of the NIAAA position paper on moderate alcohol consumption. Press release from the journal, Alcoholism: Clinical & Experimental Research, June 14, 2004; Berman, Jessica. Moderate alcohol consumption benefits heart, U.S. government says. Voice of America News, June 16, 2004. ]  (http://brookstonbeerbulletin.com/heart-health-beer/).

Soms is er vanuit de geheelonthoudershoek kritiek op deze gezondheidsclaims, maar vaak zijn die tegengeluiden ongefundeerd (zie bijvoorbeeld http://brookstonbeerbulletin.com/heart-health-beer/).

Beer prevents heart attacks and strokes
17.10.2014
Scientists reveal that beer in moderation prevents heart attack and stroke. European scientists have highlighted the beneficial health of moderate consumption of beer, including the prevention of cardiovascular problems and respiratory effects, and have excluded the myth of the 'beer belly'.
By ANTONIO CARLOS LACERDA
PRAVDA.RU
Spanish researchers from the Hospital Clinic of Barcelona, ​​University of Barcelona and the Cardiovascular Research Center (CSIC-ICCC), highlighted the potential benefits of beer, with and without alcohol on cardiovascular health, obesity, nutrition and prevention of cell aging.
'Moderate consumption of beer along with a healthy diet, like the Mediterranean, helps prevent major cardiovascular complications such as myocardial infarction or stroke," said Dr. Ramón Estruch, Hospital Clinic of Barcelona. According to him, studies in Spain have shown that non-alcoholic beer also has a protective effect against cardiovascular diseases (http://english.pravda.ru/health/17-10-2014/128822-beer_heart-0/).


Moderate consumption of beer is associated with lower cardiovascular (CV) risk. The goal of this study was to determine the effect of beer consumption on CV risk..
Aortic stiffness was significantly and similarly reduced by all three interventions. However, endothelial function was significantly improved only after beer consumption (average 1.33%, 95% confidence interval [CI] 0.15–2.53). Although wave reflections were significantly reduced by all three interventions (average of beer: 9.1%, dealcoholized beer: 2.8%, vodka 8.5%, all CI within limits of significance), the reduction was higher after beer consumption compared with dealcoholized beer (P = 0.018). Pulse pressure amplification (i.e., brachial/aortic) was increased by all three test drinks.
Conclusions: Beer acutely improves parameters of arterial function and structure, in healthy non-smokers. This benefit seems to be mediated by the additive or synergistic effects of alcohol and antioxidants and merits further investigation (www.nutritionjrnl.com/article/S0899-9007(13)00108-1/abstract).

Epidemiological observational studies consistently suggest a protective effect of regular and moderate alcohol consumption against fatal and not-fatal cardiovascular events and mortality
for any cause.
Excess of drinking, however, is definitely harmful.
This epidemiological evidence is usually described through a “J-shaped” relationship, where teetotallers and heavy drinkers are at the highest risk, whereas light-moderate drinkers are at the lowest risk (www.beerandhealth.eu/uploads/mycms-files/docs/2014/presentations/3.1_Costanzo.pdf)

(www.beerandhealth.eu/uploads/mycms-files/docs/2014/presentations/3.1_Costanzo.pdf)
Scientists at Harokopio University in Athens recruited 17 non-smoking men aged in their late twenties and early thirties.Each one had their cardiovascular health measured within an hour or two of drinking 400ml of beer - equivalent to just over two-thirds of a pint....The results, published online in the journal Nutrition, showed all three drinks had some beneficial effect on the stiffness of arteries but beer had the greatest benefit.
In a report on their findings the researchers said: ‘Endothelial function was significantly improved only after beer consumption.’They said the combination of alcohol and antioxidants in beer may be crucial to the drink’s healthy effects.
Darker beers, like stouts and ales, have been shown to be better for the heart than lager.
(www.dailymail.co.uk/health/article-2354880/Cheers-Just-ONE-pint-beer-boosts-heart-health-improving-blood-flow-make-arteries-flexible.html).

Drinking a pint of beer a day could improve the health of your heart, research shows.
Scientists found blood flow to the heart improved within a couple of hours of polishing off two-thirds of a pint - and that the effect was more powerful than drinking a non-alcoholic equivalent.
Arteries became more flexible and blood flow improved within a couple of hours of drinking the equivalent of two-thirds of a pint By PAT HAGAN FOR MAILONLINE
PUBLISHED: 15:41 GMT, 3 July 2013 | UPDATED: 22:19 GMT, 3 July 2013 (www.dailymail.co.uk/health/article-2354880/Cheers-Just-ONE-pint-beer-boosts-heart-health-improving-blood-flow-make-arteries-flexible.html).

The findings, by researchers in Greece, support previous evidence that moderate beer consumption may protect against heart disease....(www.dailymail.co.uk/health/article-2354880/Cheers-Just-ONE-pint-beer-boosts-heart-health-improving-blood-flow-make-arteries-flexible.html).

Almost 200 years ago, an Irish doctor noted that chest pain (angina) was far less common in France than in Ireland. He attributed the difference to “the French habits and mode of living.”
The comparatively low rate of heart disease in France despite a diet that includes plenty of butter and cheese has come to be known as the French paradox. Some experts have suggested that red wine makes the difference, something the wine industry has heavily and heartily endorsed. But there’s far more to the French paradox than red wine.
The diet and lifestyle in parts of France, especially in the south, have much in common with other Mediterranean regions, and these may account for some of the protection against heart disease.
Some studies have suggested that red wine—particularly when drunk with a meal—offers more cardiovascular benefits than beer or spirits. These range from international comparisons showing a lower prevalence of coronary heart disease in “wine-drinking countries” than in beer- or liquor-drinking countries. ...(http://www.hsph.harvard.edu/nutritionsource/is-wine-fine-or-beer-better/).

The substantial medical risks of heavy alcohol drinking as well as the existence of a safe drinking limit have been evident for centuries. Modern epidemiologic studies also show lower risk of both morbidity and mortality among lighter drinkers. Defining “heavy” as ≥3 standard drinks per day, the alcohol–mortality relationship is a J-curve with risk highest for heavy drinkers, lowest for light drinkers and intermediate for abstainers. A number of non-cardiovascular and cardiovascular problems contribute to the increased mortality risk of heavier drinkers. The lower risk of light drinkers is due mostly to lower risk of the most common cardiovascular condition, coronary heart disease (CHD). Thus, disparate relationships of alcoholic drinking to various cardiovascular and non-cardiovascular conditions constitute a modern concept of alcohol and health. Increased cardiovascular risks of heavy drinking include: 1) alcoholic cardiomyopathy, 2) systemic hypertension (high blood pressure), 3) heart rhythm disturbances in binge drinkers, and 4) hemorrhagic stroke. Lighter drinking is unrelated to increased risk of any cardiovascular condition and, in observational studies, is consistently related to lower risk of CHD and ischemic stroke. A protective hypothesis for CHD is robustly supported by evidence for plausible biological mechanisms attributable to ethyl alcohol. International comparisons and some prospective study data suggest that wine is more protective against CHD than liquor or beer (Alcohol and Cardiovascular Health,
Arthur L. Klatsky (2004), http://icb.oxfordjournals.org/content/44/4/324.full).
In practice, though, beverage choice appears to have little effect on cardiovascular benefit. A report from the Health Professionals Follow-up Study (Mukamal KJ, Conigrave KM, Mittleman MA, et al. Roles of drinking pattern and type of alcohol consumed in coronary heart disease in men. N Engl J Med. 2003; 348:109–18.), for example, examined the drinking habits of more than 38,000 men over a 12-year period. Moderate drinkers were 30 to 35 percent less likely to have had a heart attack than non-drinkers This reduction was observed among men who drank wine, beer, or spirits, and was similar for those who drank with meals and those who drank outside of meal time. This study suggests that the frequency of drinking may matter: Men who drank every day had a lower risk of heart attack than those who drank once or twice a week (http://www.hsph.harvard.edu/nutritionsource/is-wine-fine-or-beer-better/).

Among men, consumption of alcohol at least three to four days per week was inversely associated with the risk of myocardial infarction. Neither the type of beverage nor the proportion consumed with meals substantially altered this association. Men who increased their alcohol consumption by a moderate amount during follow-up had a decreased risk of myocardial infarction (www.ncbi.nlm.nih.gov/pubmed/12519921?dopt=Citation).

ARSENIC-BEER DRINKERS' DISEASE
In 1900 an epidemic (>6,000 cases with >70 deaths) in and near Manchester, England, was proved due to accidental contamination of beer by arsenic. Manifestations involved the skin, nervous system, gastrointestinal system and, prominently, the cardiovascular system. A superb clinical description (Reynolds, 1901) included: (a) “cases were associated with so much heart failure and so little pigmentation that they were diagnosed as beri-beri—”; (b) “the principal cause of death has been cardiac failure,” and (c) “at post-mortem—the only prominent signs were interstitial nephritis and the dilated flabby heart—.”
It was estimated that the affected beer had 2–4 parts per million of arsenic, an amount not—in itself—likely to cause serious toxicity. Gowers (1901) mentioned prescribing for epilepsy 10 times the amount of arsenic involved over long periods of time without toxicity (“the amount of arsenic—was not sufficient to explain the poisoning”). Some seemed to have a “peculiar idiosyncrasy,” in that “many persons became ill who drank less beer than others who were not affected.” An appointed committee's report (Royal Commission, 1903) suggested that “alcohol predisposed people to arsenic poisoning.” As best one can determine, no one suggested the converse (Alcohol and Cardiovascular Health, Arthur L. Klatsky (2004), http://icb.oxfordjournals.org/content/44/4/324.full).

COBALT-BEER DRINKERS' DISEASE
Recognized sixty-five years after the arsenic-beer episode, this condition was similar in some respects. Reports appeared of heart failure epidemics among beer drinkers in Omaha, Minneapolis, Quebec, and in Leuven, Belgium. The symptoms developed fairly abruptly in chronic heavy beer drinkers. The North American patients suffered a high mortality rate, but those who recovered did well despite return, by many, to previous beer habits.
The explanation proved to be the addition of small amounts of cobalt chloride by certain breweries to improve the foaming qualities of beer. Widespread use of detergents (new at that time) in taverns had a depressant effect upon foaming. Quebec investigators (Morin and Daniel, 1967) tracked down the etiology; the condition became justly known as Quebec beer-drinkers cardiomyopathy. Removal of the cobalt additive ended the epidemic in all locations.
In Belgium, the cobalt concentrations were less and the cardiac manifestations less severe, with more of the usual findings of chronic cobalt use (polycythemia and goiter). However, even in Quebec, where cobalt doses were greatest, 12 liters of contaminated beer provided only about 8 mg of cobalt, less than 20% of the dose sometimes used as a hematinic. The hematinic use had not been implicated as a cause of heart disease, whereas the first cases of this dramatic heart condition occurred 4–8 weeks after cobalt was added to beer,
It seems almost certain that both cobalt and substantial amounts of alcohol were needed to produce this condition. There must have been other factors, since most exposed persons did not develop the condition. Biochemical mechanisms were not established. Viewing the arsenic and cobalt episodes one observer (Alexander, 1969) commented: “This is the second known metal induced cardiotoxic syndrome produced by contaminated beer.”
Speculative possibilities which have been mentioned as possible cofactors for alcoholic cardiomyopathy include cardiotropic viruses, drugs, selenium, copper, and iron. Deficiencies (zinc, magnesium, protein, and vitamins) have also been suggested as cofactors, but only thiamine deficiency is proven. (Alcohol and Cardiovascular Health, Arthur L. Klatsky (2004), http://icb.oxfordjournals.org/content/44/4/324.full).

CARDIOVASCULAR BERI-BERI
Aalsmeer and Wenckebach (1929) defined, in Javanese polished-rice eaters, high-output heart failure resulting from decreased peripheral vascular resistance. Many assumed that heart failure among Western heavy alcohol drinkers was due to associated nutritional deficiency states (Keefer, 1930). A few heart failure cases in North American and European alcoholics suited this hypothesis. Most did not, however, as they had low output heart failure, were well-nourished, and responded poorly to thiamine. Chronicity and ultimate irreversibility of beri-beri, was used by some to explain the situation. Blacket and Palmer (1960) sorted the conditions out: “It (beri-beri) responds completely to thiamine, but merges imperceptibly into another disease, called alcoholic cardiomyopathy, which doesn't respond to thiamine.” In beri-beri there is generalized peripheral arteriolar dilatation creating a large arteriovenous shunt and high resting cardiac outputs. A few cases of complete recovery with thiamine within 1–2 weeks have been documented. Thus, many cases earlier called “cardiovascular beriberi” would now be called “alcoholic heart disease.” (Alcohol and Cardiovascular Health, Arthur L. Klatsky (2004), http://icb.oxfordjournals.org/content/44/4/324.full).

HYPERTENSION (HIGH BLOOD PRESSURE)
Almost 90 years ago Lian (1916) reported a relationship between heavy drinking (mostly as wine) and hypertension (HTN) in WW1 French servicemen. Unless these soldiers exaggerated, they were prodigious drinkers, as the HTN threshold appeared at ≥2 liters/ wine per day. No further attention was given to this subject for almost 60 years. Since the mid 1970s, dozens of cross-sectional and prospective epidemiologic studies (Beilin and Puddey, 1992; Klatsky, 2000) have solidly established an empiric alcohol-HTN link. The apparent threshold for this relationship is approximately 3 drinks per day. The studies involve both sexes, various ages and populations in North American, Europe, Australia, and Japan. Importantly, most studies show no increased HTN with lighter drinking; in fact, several show an unexplained J-shaped curve in women with lowest pressures in lighter drinkers. The relationship is independent from several potential confounders such as adiposity, salt intake, education, smoking, and beverage type (wine, liquor, or beer). (Alcohol and Cardiovascular Health, Arthur L. Klatsky (2004), http://icb.oxfordjournals.org/content/44/4/324.full).

ARRHYTHMIAS
Based on the observation that heart rhythm disturbances were more frequent on Mondays and in the Christmas-New Year's Day period, the term “holiday heart syndrome” was born (Ettinger et al., 1978). An association of heavier drinking with atrial arrhythmias had been suspected for decades, perhaps occurring especially after a large alcohol-accompanied meal. Atrial fibrillation is the commonest manifestation, typically resolving with abstinence, with or without specific treatment. In 1,322 persons reporting intake of ≥6 drinks per day a Kaiser Permanente study found a doubled relative risk of atrial fibrillation, atrial flutter, supraventricular tachycardia, and atrial premature complexes (Cohen et al., 1988). (Alcohol and Cardiovascular Health, Arthur L. Klatsky (2004), http://icb.oxfordjournals.org/content/44/4/324.full).